Provider Demographics
NPI:1093282089
Name:RAITT, CAROLYN ANN (LCPC, NCC, CCTP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:RAITT
Suffix:
Gender:F
Credentials:LCPC, NCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N MICHIGAN AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7939
Mailing Address - Country:US
Mailing Address - Phone:872-395-8091
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 450
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7939
Practice Address - Country:US
Practice Address - Phone:872-395-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-27
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014207101YP2500X
IL180.013541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional